Impact of depression on the academic performance of international students in Udayana University

Background: Depression is a mental disorder that affects an individual’s mood and emotion. Depression is very common among the students. In this study, the impact of depression, especially on the academic performance of students who are abroad, studies along with the risk factors of depression.

Aim: The study aims to know the relationship between depression and the academic performances of international students studying abroad.  

Method: In this analytic study, a cross sectional method was being used. This method is being used to analyze the relationship between the factors that influence the academic performance and also to investigate the relationship between depression and academic performance of the students.

Result: As for the residence factor, the student who was lived alone performed better in academic. For the method of study factor, the student who conducts independent learning performs well in academic whereas for the factor back to Malaysia in a year, the students who go back to Malaysia less than or twice a year performs better in their academic. As for the family support factor, students who have good family support obtain good results in academic performance, but for factor family financial support, students with inadequate financial support obtain good results in their academic.

Karakteristik anemia pada lansia di RSUP Sanglah Denpasar pada bulan Januari-Juni 2017

Background: Anemia is a symptom depending on the decrease of hemoglobin levels, the number of erythrocytes, and the volume of erythrocytes. The symptoms of anemia commonly occur in the elderly. In general, the common causes that often complained in the elderly are less efficient in absorbing some of the nutrients, decreased appetite due to illness, difficulty swallowing due to reducing of saliva, slow feeding, reduced teeth, and nausea. Anemia in the elderly should not be considered as an unavoidable consequence of aging. Treatment of this problem should start as early as possible.

Aim: This study aims to determine the characteristics of anemia in the elderly in RSUP Sanglah from January to June 2017.

Method: This research is a descriptive cross sectional study conducted at RSUP Sanglah Denpasar. Data obtained in the form of secondary data patient record period January  - June 2017. Data were analyzed using Microsoft Excel 2010.

Result: Of the 102 patients, the average age was 69.3 ± 7.1 years with the highest proportion of patients aged 60-70 years old is 56 people (54.9%). The proportion of male is 71 people (69,6%). Of the total samples, there were 75 patients anemia patients  (73.5%) and 27 patients without anemia (26.5%). The highest proportion of anemia depend on their stages are 51 patients of mild anemia (68%). 47 patients (62.7%) were normochromic and normocitary anemia. The highest proportion is anemia with kidney disease (38,7%).

Karakteristik diare pada anak di RSUP Sanglah Denpasar tahun 2017

Background: Diarrhea is one of the most common diseases affecting children around the world. In Indonesia, the national rate of diarrhea prevalence is 9% where 16.7% of cases occur at 1-4 years old and 16.5% of cases at under one year old. In addition, dehydration causes most mortalities.

Aim: This study aims to determine the characteristics of diarrhea in children in Sanglah General Hospital, Denpasar.

Method: Thisstudyis a cross-sectional study design using secondary data from the register data in the Pediatric Division of Sanglah General Hospital Denpasar from January to November 2017. Of the 170 data, there were 165 survival samples. Characteristics of diarrhea in children are described using tables, pie charts, and graphs.

Result: Most of the sample were males (56.5%), infants (40%), patients from Denpasar (55.3%) and those with good nutritional status (60%). The mean age of the patient was 26.6 months, the mean body weight was 10.6 kg, and the mean height was 79.8 cm. Most of them were diagnosed with acute diarrhea (98%), where the most common cause is a viral infection (75%). The most common comorbid diseases are congenital heart disease and neurological disease (10.6%). Most patients have only mild dehydration (57%). Long term treatment of diarrhea patient in child wards mostly for 2-3 days.

Conclusion: Diarrheain children in Sanglah Denpasar Hospital period January-November 2017 most suffered by men and babies, mostly from Denpasar. Most of them have acute diarrhea that is mainly caused by a viral infection.

Karakteristik ibu hamil dengan hiperemesis gravidarum di RSUP Sanglah Denpasar tahun 2017

Background: Hyperemesis gravidarum is severe and over vomiting suffered as of early in pregnancy until 20 weeks of gestation. It may be harmful to the mother's health that can lead to weight loss of more than 5% and cause metabolic disorders. If it does not get proper treatment, it affects complications, even maternal and fetal deaths.

Aim: The study aims to generalize the characteristic of pregnant patients who suffered hyperemesis gravidarum in Sanglah General Hospital.

Method: This study is a cross sectional retrospective descriptive study with data retrieval on patient records for one year in 2017. This research was conducted at Space Cempaka Obstetrics and Medical Record Division Sanglah Hospital Denpasar.

Result and Conclusion: pregnant women with hyperemesis gravidarum based on mother’s age is highest experienced by pregnant women in the age group 20-35 years as many as 6 people (75%). Based on maternal age, pregnant women with hyperemesis gravidarum is highest experienced by pregnant women in the first trimester as many as 5 people (62.5%). As regard with the parity,  it was highest experienced by pregnant women in the parity group nullipara as many as 4 people (50%). Moreover, maternal education is highest academic of pregnant women who have junior high and high school education, each of them as many as 3 people (37.5%). Based on the job status is highest experienced by pregnant women who work as many as 5 people (62.5%).

Red meat intake as a suspicious factor of colorectal cancer at Sanglah General Hospital in 2017

Background: Colon and rectal cancer (colorectal cancer) is cancer with high morbidity and mortality. Colorectal cancer is the second leading cause of death among men and women. This cancer is also the third most common malignant neoplasm in the world, and its incidence has increased in recent years. A high diet of red meat is one of the risk factors that can increase the likelihood of colorectal cancer.

Aim: The study aims to determine the relationship between red meat consumption on the incidence of colorectal cancer.

Method: This study is an unmatched paired case-control study conducted in Sanglah Hospital using patient medical record data from 2016 to 2017. The number of colorectal cancer group and control group samples are 52 people, each group. Samples were then interviewed on the red meat diet using the questionnaire guidelines. Data on the diagnosis of colorectal cancer was obtained through the patient's medical record at Digestive Surgery Polyclinic, Sanglah Hospital, Denpasar.

Result: About 76.9% of colorectal cancer patients consume a high intake of red meat. Patients with colorectal cancer have a history of higher red meat intake than patients without colorectal cancer (OR = 9.048; 95% CI 3.716-22.026; p<0.001).

Conclusion: Red meat intake is a significant factor in the incidence of colorectal cancer in Sanglah Hospital. Limiting the consumption of red meat is recommended to reduce the risk of colorectal cancer.

Pola Kuman dan Uji Kepekaan Antibiotik Pada Pasien Unit Luka Bakar RSUP Sanglah Periode 1 Januari 2016 - 1 Januari 2017

Background: Burns are a skin injury or injury caused by thermal that causes morbidity or mortality in patients, due to either heat or radiation, electrical and chemical reactions. In burns can occur bacterial growth that will cause an infection, both gram-positive bacteria and gram-negative bacteria. Necessary antibiotics in the treatment of infection by bacteria on burns. The incidence of burns is increasing from year to year, but data in Indonesia that discuss about the number of infections in burns and the use of antibiotics is still small.

Aim: The study aims to determine the pattern of germs and antibiotic sensitivity test in patient burn unit at Sanglah Denpasar Hospital period January 2016 - January 2017.

Method: This research is a descriptive descriptive cross sectional study conducted at Sanglah Denpasar General Hospital (RSUP). Data obtained in the form of secondary data of medical record of patient period January 2016 - January 2017. Data were analyzed by using SPSS program.

Result: The results showed that from 63 patients, found 51.0% gram positive and 49.0% gram negative. In the positive gram found 8 species of bacteria with the most bacteria that is Staphylococcus aureus 15.87% and Strep β Haemolyticus 15.87% and gram negative found 3 types of bacteria with the highest number Pseudomonas aeruginosa 30.16%.

Conclusion: Antibiotics with the highest resistance were found Amoxicillin 85.7%, Amoxicillin / Sulbactam 81.2% and Ampicillin 87.5% while the highest sensitivity antibotics were Amikacin 82.3%, Meropenem 75.0% and Linezolid 85.7% both on gram negative and gram positive.

The influence of light physical activity on scale of pain in elderly with knee osteoarthritis

Background: Osteoarthritis (OA) is a collection of mechanical variations of joint thinning, including the articular ligament and the subchondral bone.

Aim: This study aims to find out how some light physical activity correlates with the pain scale among elderly with knee osteoarthritis and also to find out whether light physical activity in the elderly helps reduce pain in knee osteoarthritis.

Method: This research is a descriptive cross sectional study. The sample in this study was elderly people aged 50 years and above with a total of 70 samples were selected using multistage random sampling technique located in Badung Market, Kumbasari Market, and Renon Field. Data were obtained by interviewing respondents who previously provided informed consent using structured questionnaires. The degree of pain caused by osteoarthritis was measured using The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the total score.

Results: Distribution of sex within samples found that women (54.3%) and men (45.7%). Researchers found that the mean age of respondents was 61.2 (SD + 3.75) years. The total number of respondents who have exercise habits is 52.9%. The average WOMAC score was 23 (SD +2,319) with a minimum score of 18 and a maximum of 27. Respondents with WOMAC score <23 were 52.9% whereas respondents with WOMAC score> 23 were 47.1%. Cross-tabulation results showed 97.3% of respondents with a WOMAC score <23 had exercise habits.

Conclusion: The exercise habits of the elderly with knee osteoarthritis can reduce pain when measured using a 0-4 scale and the WOMAC pain scale.

Pengaruh kepatuhan pendokumentasian asuhan medis terhadap kelengkapan dokumen pengajuan klaim JKN di Instalasi Rawat Inap RSUD Badung tahun 2018

Background: BPJS as a health insurance institution runs the National Health Insurance (JKN) program. JKN implements a prospective financing system whereby payments made after the provision of services are in accordance with the agreement at the beginning in the form of packages. As regard with the fee, the hospital should take an effort to submit the proof document as the condition for the filing of the claim.

Aim: This study aims to determine the effect of medical documenting compliance with the completeness of the JKN claim filing documents at the inpatient installation of Badung Hospital.

Method: This study is a cross-sectional analytic study with the sample used is 120 documents of in-patient medical treatment that has been repatriated at the in-patient installation of Badung General Hospital in February 2018.  

Results: This research get result that the price r_s = 0.861 and p-value = 0,003.

Conclusion: There is an effect of compliance with documenting medical care on the completeness of claim filing documents in the in-patient installation of Badung General Hospital.

Gambaran hasil pemeriksaan faal hemostasis pada penderita Diabetes Melitus tipe-2 (DM-2) di RSUP Sanglah, Bali, Indonesia

Background: Diabetes Mellitus Type II (DM-2) is a type of hyperglycemic state which is related to metabolic disorders caused by mutations in several genes. Faal hemostasis is a function of the body that aims to maintain the blood that has been thinned so that the blood flowing in the veins and could be interfere with blood glucose level. This study aims to describe the faal hemostasis examination in patients with DM-2 in Sanglah Hospital.

Methods: A cross-sectional study was conducted among patients with diabetes mellitus type II (DM-2) who were hospitalized in Sanglah hospital at the period started from January 1^st to December 31^st, 2015. The sample selection were using consecutive sampling with a total of twenty eight samples. Data were analyzed using SPSS version 17 for Windows

Results: The study found that males were predominant in this study (53.6%). In addition, 51-60 years age group were also predominant (39.3%), following by history of hypertension (82.1%), 10-14 seconds of Prothrombin Time (PT) (67.9%), 30-40 seconds of Activated Partial Thromboplastin Time (APTT) (53.5%), and bleeding time (BT) > 1.3 minutes (67.9%).

Conclusion: Several faal hemostasis assessments were predominant in patients with DM-2 such as 10-14 seconds of PT, 20-40 seconds of APTT, and bleeding time more than 1.3 minutes.

Awareness of colorectal cancer risk factor among students at Faculty of Medicine, Udayana University, Bali

Introduction: Colorectal cancer is a major cause of morbidity and mortality throughout the world. To identify the presence of colorectal cancer, screening that is recommended can be carried out. Screening is an important process in every disease including colorectal cancer

Method: This is crossectional-descriptive research. 100 samples that met inclusion criteria were included in the research. Samples obtained using consecutive sampling technique. The samples were interviewed to obtain the data used to fill out the questionnaire

Result: 74% of the student has answered that a history of personal cancer are risk factors of colorectal cancer and also 88% of students have answered family history also a risk factor for colorectal cancer. The students have less knowledge on risk factors such as Inflammatory Bowel Disease (64%) and eating spicy food (60%). 87% of students agree that knowledge on colon and rectal cancer is important to prevent colorectal cancer.

Usia dan obesitas berhubungan terhadap penyakit batu saluran kemih di RSUP Sanglah Denpasar periode Januari 2014 sampai Desember 2014

Introduction: Urinary Stone Disease is the process of forming stones caused by the deposition of a substance with excess amounts of urinary or due to other factors that affect the solvency of substance. Urinary Stone Disease is frequently   found on adults between 15-59 years old. Total patient who diagnosed by Urinary Stone Disease in Indonesia is too high. Many things associated against the onset of this disease, such as age and obesity. Therefore the research to examine which factors cause the occurrence of Urinary Stone Disease is necessary in order to raise the early prevention.

Method: Research design is descriptive analytic. Using consecutive sampling method. Data will be analyzed in univariate and bivariate using statistical test of chi-square with a level of significance of α < 0.05. Place of research in Sanglah Denpasar Bali Subject of research are men and women above 15 years old, diagnosed with Urinary Stone Disease. Subject research are urology unit visiting patient also patient being hospitalized at Sanglah General Hospital.

Result: The research results showed that the age has become risk factors which closely related with Urinary Stone Disease, value of p = 0.002. Obesity does not have significant relations against the occurrence of Urinary Stone Disease with value of p = 0,564.

Hubungan insomnia dengan depresi pada lanjut usia di Sesetan Kecamatan Denpasar Selatan Tahun 2017

Introduction: Insomnia is difficulty falling or maintaining sleep that often experienced by general population. Insomnia mostly experienced by elderly woman, people with low education and low economy and in people  who  have  chronic  disease.  Insomnia  is  risk  factor  from  psychiatric  disorder  especially depression. Insomnia increase the risk in depression development. Depression is disorder on personal, interpersonal  and social that affecting general population. The purpose of this study is to know the relationship between insomnia and depression in elderly.

Method: The type of this study is analytical observational (Cross-sectional)  study with amount of sample 32 respondents that conducted in Banjar Gaduh and Banjar Tengah in Sesetan, South Denpasar District in elderly in 2017. This study is using the primary data obtained through questionnaire and interview (GDS and ISI) and analyzed through SPSS 21.0.

Result: This study found that from 32 respondents experienced insomnia (50%), not experienced Insomnia   (50%),  experienced   depression   (28.1%)  and  no  experience   depression   (71.9%)  and relationship insomnia with depression on eldery obtained value p < 0.05 . The R-square value indicates value of 0.673 which means that role variable independent in explain variable dependent only of 67.3%, could be concluded that still there are 24.6% other variables outside the research variables that affect insomnia.

Conclusion: There were a significant relationships between depression and insomnia.

Perbedaan stress kerja pada perawat di ruang unit gawat darurat dengan perawat di ruang rawat inap Rumah Sakit “S” di Kota Denpasar tahun 2017

Hubungan lingkar perut dengan kadar gula darah puasa pada mahasiswa Fakultas Kedokteran Universitas Udayana angkatan 2014

Introduction: Diabetes Mellitus is a metabolic disease characterized by elevated blood sugar levels, either caused by a disturbance of insulin secretion, insulin resistance or both. Obesity is one of the risk factors of diabetes mellitus. The incidence of diabetes mellitus increases from year to year, but the data that discusses the association of risk factors with diabetes mellitus itself, especially obesity is minimum. The purpose of this study is to determine the association of abdominal circumference with fasting blood sugar levels at students of Udayana University Faculty of Medicine class of 2014.

Method: This research is an analytical research conducted at Udayana University Faculty of Medicine Campus, Denpasar. Data obtained in the form of primary data in the form of abdominal circumference to see the status of obesity and fasting blood sugar to see the status of diabetes mellitus. Data were analyzed using SPSS program.

Result: The results showed that there was not significant negative association between abdominal circumference with fasting blood sugar levels at Udayana University, Faculty of Medicine students class of 2014. However, this association is not statistically significant because diabetes mellitus influenced by many factors other than obesity. In addition, it can be seen that the characteristics of the population did not describe the population of diabetes mellitus or obesity, thus affecting associations that have been described in some literature and the concept of author thinking. But indeed the association of anthropometric risk factors (abdominal circumference) has a greater value than other risk factors.

Conclusion: There was a negative correlation between abdominal circumference and fasting blood sugar but not significant statistically

Hubungan antara obesitas dan insiden kanker kolorektal di RSUP Sanglah tahun 2016-2017

Introduction: Colorectal cancer is the third malignant disease in Indonesia. Obesity is one of the risk factors related to colorectal cancer. This research aims to role out relationships between obese and age to the incidence of colorectal cancer at Sanglah General Hospital.

Method: Study design using case-control analytic model, covering 274 samples, divided into the group of colorectal cancer (137 persons) and non-cancer samples (137 persons). Secondary data were used for analysis obtained from medical records in year period of 2016-2017 at Sanglah General Hospital. Data were analyzed using Chi-square analysis and risk estimate model.

Result: The result showed that the majority of colorectal cancer patients were male (53.3%), meanwhile for non-cancer patients were female (50.4%). The average age of colorectal cancer patients was 54 years old while 42 years for non-colorectal cancer patients. Based on the BMI groups, majority of cancer colorectal patients (62%) belongs to obese, while only 39.4% for non-colorectal cancer patients. Result of analysis showed that there is significant relationship between obese and the incidence of colorectal cancer (p value <0.001), with the risk increase of prevalence by 1.588 times higher for those patients with BMI ≥23.00 kg/m² (95% CI 1.235-2.040). Result from the Chi-square test also indicated that there is significant relationship between age above 40 years and the incidence of colorectal cancer (p value <0.001).

Conclusion: It can be concluded that there is significant relationships between obese and age above 40 years to the incidence of colorectal cancer.

Gambaran fraktur elbow pada anak-anak di RSUP Sanglah tahun 2012-2013

Introduction: Fracture is a loss of bone continuity, either total or partial, usually caused by trauma. Fractures in children are more common due to the immature musculoskeletal system, this is because the child is more susceptible to tears on joint surfaces, epiphyseal plates, aphophyseal insertion of large tendon muscle units. This study aims to determine the prevalence of elbow fracture in children at Sanglah Hospital Denpasar in 2012 until 2013.

Method: Study design using cross-sectional method, evaluating the characteristics of elbow fracture in children at Sanglah General Hospital in the period 2012 to 2013.

Results: Males tend to have more elbow fractures compared with females with a 73% proportion, based on the cause of overall fracture of the sample due to falling during activity, based on the fracture type  more subjects experiencing fractures of the supracondylar humerus fracture compared with olecranon fractures as much as 93%.

Conclusion: The prevalence of elbow fracture in children in Sanglah General Hospital in 2012-2013 is 15 cases, all caused by falling during the activity. The type of elbow fracture found in most children is a supracondylar humerus fracture.

Gambaran umum berbagai faktor keterlambatan pemberian nutrisi enteral pada pasien anak di Ruang Rawat Intensif Anak, RSUP Sanglah, Denpasar, Bali

Background: Enteral nutrition is the primary choice in pediatric patients who do not experience gastrointestinal disorders. Many factors inhibit the achievement of enteral nutrition in pediatric patients treated in intensive care. This study aims to determine the overview of various factors that may result in delays enteral nutrition administration in critically ill pediatric patients

Methods: An observational cross-sectional analytic study was carried out on secondary data of medical records among children who were treated in pediatric intensive care unit at Sanglah Hospital throughout 2016. Delay in enteral nutrition was assessed if there was enteral nutrition administration more than 2x24 hours since first admission. Factors assessed include gender, age, PELOD, diagnosis, invasive breathing aids, impaired motility, gastrointestinal bleeding, and hemodynamic instability. Data were analyzed using the SPSS version 20 software program whereas P value <0.05 was considered statistically significant.

Results: From the 115 samples, there were 69 (60%) males and 46 (40%) females. About 50 samples (43,5%) experienced delayed enteral nutrition. Significant variables related to the delay in enteral nutrition after multivariate analysis were gastrointestinal motility disorders (p = 0,004, OR 9,082, 95% IK 2,827 – 29,171), and gastrointestinal bleeding (p = 0,0001; OR 14,317; IK 95 % 4,087 – 50,155).

The effect of young pepaya leaf ethanol extract (Carica papaya L.) with concentration variants on the growth of pathogenic Streptococcus pyogenes bacteria causing pharyngitis through in vitro testing

Background: Pharyngitis infection issues by Streptococcus pyogenes bacteria have been increasing worldwide, and antibiotic resistance to the bacterium treatment also continues to escalate. Young papaya leaves (Carica papaya L.) have a bactericidal and bacterostatic effect (include papain, flavonoids, alkaloids (karpain alkaloids), saponins, glycosides, phenols (tacophenol), and tannins) that can be an option for treatment of pharyngitis infections other than drugs. This study aims to determine the effectiveness of ethanol extract of young papaya leaves (Carica papaya L.) in inhibiting the growth of Streptococcus pyogenes bacteria through in vitro testing.

Methods: This study was a true-post experimental study using control group design. The sample was divided into 2 groups: positive and negative control groups as well as treatment groups with concentration variants of 25%, 50%, 75%, and 100%. Data were analyzed using SPSS version 17 software for windows.

Results: The result obtained from this study showed that papaya leaf extract (Carica papaya L.) was proven to significantly inhibit the growth of Streptococcus pyogenes bacteria at concentrations of 25% to 100% with an average diameter of the inhibition zone of 6.4 mm to 7.4 mm (P<0.05).

Conclusion: This evidences that the ethanol extract of young papaya leaves (Carica papaya L.) with various concentrations does exhibit an influence on the growth of Streptococcus pyogenes bacteria.

Hubungan komunikasi efektif dokter-pasien terhadap tingkat kepuasan pasien dalam pelayanan medik

Introduction: Indonesia is the biggest contributor of medical tourists to Malaysia and Singapore in recent years, mostly from Medan. Literature reviews and experts opinion of community medicine revealed that poor doctors’ communication skills in Indonesia lead to decreased patients satisfaction and lead to the number of patients seeking treatment abroad.

Aim: This study aimed to analyze the relationship between physician-patient communication on the level of patient satisfaction in Central Public Hospital Haji Adam Malik, Medan.

Method: This research uses a combination of descriptive-analytic study with cross sectional design. Statistical analysis was performed by chi-square test. The sample selection of research done by consecutive sampling. Measurement doctor-patient communication and patient satisfaction rate is determined by using modified CAT (Communication Assessment Tool) questionnaire.

Result: Ten outpatient clinics of Central Public Hospital Haji Adam Malik (10 patients per outpatient clinic) participated in the field test. The average mean score was 4.086 across all modified CAT items (SD = 0.609, range 2.23-5.00). The average proportion of satisfaction rate was 81.7% (S.D. = 12.19, range 44.62-100%). There was a significant relationship between physician-patient communication with patient satisfaction (p <0.05).

Prevalensi dan karakteristik obesitas pada anak di Sekolah Dasar Saraswati V Kota Denpasar tahun 2016

Introduction: One of the problems of excess nutrients that occur in children and received special attention in the world of health is obesity. Obesity itself can be defined as the accumulation of excess fat raises the risk of health problems. The prevalence of obesity in children in the world between 1980 and 2013 increased by 47.1%. Childhood obesity has both immediate effects and long-term health. This study aims to determine the prevalence and characteristics of obesity in children at elementary school.

Method: This research is a descriptive cross sectional study, conducted in Saraswati V Denpasar elementary school, November - December 2016, by taking samples of obese children in Saraswati V elementary school Denpasar 2016.

Result: From the results, 17.2% children with obese, 18.2% children with overweight, 54.6% children with normal BMI, and 10.0% children with underweight from total students many as 1003 children. While the characteristics of obese children obtained: 62.2% of obese children aged <9 years, 73.4% of obese children of boy, 86.7% of obese children have birth weight ≥2500 gram, 62.9% do breakfast, 98,6% escorted to school, 67.8% had obese father and 34.3% had obese mothers, 99.3% had educated father and 97.2% had educated mother.

Displasia ektodermal tipe hipohidrotik pada seorang anak bayi tiga tahun

ABSTRACT

Introduction: Ectodermal dysplasia (ED) is a rare genetic disorder characterized by defect in two or more ectodermal structures such as teeth, hair, nails and sweat glands. Ectodermal dysplasia divided into 2 types, which is hidrotic and hypohidrotic. The hypohidrotic type was found in 80% of cases. There is no specific treatment for this disorder, which is more of a symptomatic measures depends on the structure involved.

Case: A 1 year old male, Balinese, consulted from Department of Pediatrics to Department of Dermatovenereology with the chief complaint of dry skin, absence of sweat, teeth, scalp hair and eyebrow since birth. Recurrent fever present especially in hot climates. No growth abnormalities. No history of incest between parents. His grandfather also complained about the same symptoms, which are sparse hair and decreased sweating. General examination revealed frontal bossing, saddle nose, prominent chin and anodontia. Dermatologic examination revealed multiple hypopigmented macules, well defined margin, oval-round shaped, size ø 0,5-1 cm, distributed over entire skin and anhidrosis. Department of Dermatovenereology gives moisturizer every 12 hours topically. Department of Pediatrics gives zinc tablets, 20 mg every 24 hours orally.

Conclusion:The diagnosis of ED was mainly clinical. Treatment is symptomatic and effective education is needed to increase patient's quality of life. Early fetal detection can be performed if there is a risk in the family. Currently, there is a team joined under SIDIC program in Sanglah Hospital whose main purpose is to detect and prevent congenital disorders early.

Perbedaan rerata kadar protein-C pada sepsis neonatorum dengan kultur positif dan negative di RSUP H. Adam Malik Medan tahun 2018

Background: First ten months from conception is a period of susceptibility to infection. Diagnostic testing for disease must be conducted as quickly as possible for antimicrobial administration. Blood culture, the 'gold standard' for diagnosis, is full of shortcomings. Decreasing protein C levels are characteristic of sepsis due to an increase in consumption, degradation, or decreased synthesis, so that the onset of protein C deficiency may occur before the diagnosis of sepsis.

Aim: The study aimed to determine the difference in mean serum C protein levels in septic neonatorum in which positive cultures compared with negative cultures

Methods: The sample in this study were septic neonatorum patients in the perinatology unit of H. Adam Malik General Hospital Medan by consecutive sampling technique. The blood was incubated in BACTEC 9050 and identified with gram staining, gram-positive identified by catalase, coagulase and MSA tests, while gram-negative with API 20E. Protein C was examined with Coatron A4. A bivariate analysis determined differences in protein C in septic neonatorum with positive and negative cultures.

Result: The prevalence of positive culture sepsis was 36.1%. The most common pathogens were Staphylococci epidermidis (19.4%). There was no significant difference in protein C levels between the septic neonatorum with positive and negative cultures (p = 0.166). Positive culture sepsis is a risk factor associated with protein C decreasing with p = 0.011. Positive culture sepsis had a higher risk of reducing protein C levels by 7.536 times compared to negative culture sepsis.

Conclusion: There were no significant differences in protein C levels between septic neonatorum with positive and negative cultures, but sepsis was significantly associated with a decrease in C protein levels.

Analisis hubungan Rasio Trombosit Limfosit (RTL) dengan derajat keparahan stenosis pada pasien Coronary Artery Disease (CAD)

Background: Atherosclerosis in CAD is marked by formation of plaque inside the arterial lumen. Platelet plays a role on formation and development of atherosclerosis. Adhesion of platelets to the endothelial cells followed by releasing platelet granules caused inflammation of endothel. Lymphocytes also play a role in atherosclerosis and atherotrombosis. T lymphocyte was the first to be recruited inside atheromas and gathered along inside an unstable plaque. The severity of stenosis can be calculated using Gensini score. The Aim of this study is to analyze the correlation between PLR and degree of stenosis in CAD.

Methods. This study is a retrospective study by collected 110 patients with CAD that had undergone coronary Angiography. Platelets and lymphocyte count were measured by automatic haematologycal analyzer. PLR was measured by dividing trombocyte count with absolute lymphocyte. Angiography findings were calculated using Gensini score and later devided into 3 groups according to degree of severity.

Results. 110 patients retrospectively assesed, 80% were male and 20% female. The most age found was 50-59 years (35.5%). Using Anova test there is a significant differences on  PLR between 3 groups of lesions (p<0.05). Continued with Posthoc test, the only significant finding was PLR between moderate and severe lesion. By Spearman’s Correlation test, there is a positif colleration between PLR and severity of stenosis (p<0.048), with R value 0.189 (3.6%).

Conclusions. There was a poor correlation between PLR and degree of stenosis severity in CAD. A prospective study needed to assess PLR as predictor of mortality and morbidity in CAD.

Hubungan kadar ferritin dengan TSH dan FT4 akibat transfusi berulang pada penderita thalassemia di RSUP Dr. Kariadi, Semarang, Indonesia

Perbandingan profil lipid dengan hipertensi pada diabetes mellitus tipe 2 dengan atau tanpa hipertensi di RS H. Adam Malik, Medan, Indonesia

Background: Atherosclerosis is a complex process. It involve many pathological event including endotelial dysfunction, abnormal lipid metabolism, trombosit activation, trombosis, oxidative stres, activation smooth muscle in blood vessel. Recently, it is known that inflamation plays a role in every steps of atherosklerosis formation. Diabetes Mellitus (DM) is the main risk factor of cardiovascular disease. The epidemiology showed that cardiovasculer mortality 2 to 3 times higher compared to population without DM. This study aims to know the difference in lipid profile between type 2 diabetics’ patients with and without hypertension.

Method: This is a cross sectional study, which was held in Patology Clinic Department FK-USU / H. Adam Malik Hospital, from Agustus 2017 to November 2017. Target population is type-2 DM. Data were analyzed using SPSS version 17 for windows.

Result: It found 72 subject is 36 people as patient DM type 2 with hypertension and 36 people as control. According to statistic analysis found significant difference between total cholesterol, triglyceride, HDL and LDL in patients with DM type 2 and hypertension compared with patients with DM type 2 without hypertension (p < 0,05).

Hubungan kadar troponin I dan high-sensitivity troponin I dengan angiografi koroner pada pasien suspek coronary artery disease: studi di Rumah Sakit Umum Pusat dr.Wahidin Sudirohusodo Makassar-Indonesia tahun 2017

Background: Coronary artery disease (CAD) is a narrowing of blood vessels due to the formation of atherosclerotic plaques which can cause disruption of oxygen supply to the heart. High sensitivity troponin I (hs-TnI) is a diagnostic tool for detecting heart disorders with minimal injury to the heart muscle.

Aim: The study aimed to compare and observe the relationship of troponin I (TnI) and hsTnI with /RSUP dr.Wahidin  Sudirohusodo Makassar.

Methods: The design of the study was cross-sectional study, using primary data of blood samples from 31 suspected CAD patients who underwent coronary angiography examination at RSUP Dr.Wahidin Sudirohusodo Makassar. Samples were taken from a population of subjects who met the inclusion criteria by using consecutive sampling technique in the period of September 2018. Statistical analysis were done using descriptive statistical calculations, frequency distribution and, Spearman’s correlation test. The test results were considered significant if p<0.05.

Results: CAD was more common in men at the age of 50-69 years. Data analysis showed a significant correlation between TnI, hsTnI, and the degree of stenosis (p<0.001). The correlation coefficient of TnI and degree of stenosis was 0.707, hsTnI with degree of stenosis was 0.877, and TnI with hsTnI was 0.804.

Karakteristik anak yang mengalami child abuse dan neglect di RSUP Sanglah, Denpasar, Indonesia tahun 2015-2017

Background: Child abuse and neglect is any form of physical, emotional, sexual abuse, or neglect of children. Child abuse causes various consequences that are harmful to the child and the future of the nation. The purpose of this study was to determine the characteristics of children who experience child abuse at Sanglah Hospital Denpasar.

Methods: A cross sectional study design was conducted using secondary data taken from medical records of the Forensic Medicine Department, Sanglah General Hospital Denpasar from January 2015 to December 2017. Data related to age, gender, origin, types of abuse, and perpetrator’s house were analyzed as percentage using SPSS version 17 software. Ethical clearance was carried out prior study conducted.

Result: From 2015 to 2017, 173 subjects were recorded as child abuse. The age group of 13-15 years and 16-18 years is the highest age group that experiences child abuse which is 28.3% and 33.5%. Subjects of female sex were 56.0%. The highest distribution of subject origin comes from Denpasar area 20.8% and the highest education level of parents is 45.0% senior high school. Subjects who experienced physical violence and threats were 93.6%, sexual violence was 50.8%, and 1.7% experienced neglect. The perpetrators of child abuse are mostly people who are known to the victim. The perpetrator's or subject's house is the place where most physical, emotional, or sexual violence occurs, which is 72.2%, 69.7%, and 89.7% respectively.

Gambaran sindrom metabolik pada pasien gangguan jiwa yang dirawat di rumah sakit jiwa provinsi Bali

Introduction: Metabolic syndrome (MS) is a constellation of various disorders that can increase the risk of heart disease. MS is known to increase morbidity and mortality rates in psychiatric patients. However, MS in the population of mental disorders, especially in Bali, is still not well known.

Methods: A cross-sectional analytic descriptive study was conducted in psychiatric patients treated at Bali Provincial Mental Hospital from January 2018 to February 2018. Inclusion criteria included inpatients who diagnosed with mental disorders based on DSM-IV criteria and those who had MS based on the National Cholesterol Education Program Adult Treatment Panel (NCE ATP III) criteria.

Results: A total of 245 samples were included in this study with the prevalence of MS was 48.6%. According on sex, female had higher proportion among MS patients than male (42.8% vs 60.7%). In addition, the age group > 65 years had the highest frequency (75%) suffered from MS followed by age group of 45-65 years (54,9%). Based on the class of antipsychotic administered, MS patients with typical antipsychotic drug classes had the highest frequency, followed by the atypical group and combination of atypical and typical (49.4%, 49.3%, and 46.2%, respectively). Among MS patients, most of them had obesity (87.3%), followed by dyslipidemia, hypertension and impaired fasting glucose (76.4%, 65.5%, and 60.4%, respectively).

Conclusion: There is a high prevalence of metabolic syndrome among patients with mental disorder admitted to the Mental Hospital of Bali Province. Comprehensive multidisciplinary co-operation is required in the treating those with metabolic syndrome as comorbid.

Hubungan antara TIL (Tumor Infiltrating Lymphocyte) dan MAI (Mitotic Activity Index) dengan kejadian metastase kelenjar getah bening (KGB) aksila pada operable breast cancer di RSUP Sanglah, Denpasar.

Latar belakang: Kanker payudara merupakan penyakit yang menduduki urutan ketiga di Eropa dan United State sebagai jenis kanker yang menyebabkan kematian. Studi dua dekade terakhir mengungkapkan bahwa Tumor microenvironment (TME)juga merupakan penentu penting perilaku tumor.Tumor padat umumnya terdiri dari berbagai sel kekebalan tubuh, termasuk limfosit T dan B, sel NK, makrofag, dan neutrofil. Imunitas adaptif dan imunosupresi selalu menunjukkan tingkat ekspresi yang berbeda pada tumor, dan banyak gen kekebalan terkait dengan inflamasi. Interaksi antara sel imunitas menentukan induksi atau penghambatan perkembangan tumor, angiogenesis, dan metastasis. Sistem imunitas mempengaruhi surveillance pada pasien kanker. Proliferasi telah dikenali sebagai “hallmark” dari kanker dan merupakan faktor prognostik kanker. Evaluasi dari derajat proliferasi sel dalam jaringan tumor digunakan untuk menilai progresifitas tumor. Penilaian indeks mitosis telah digunakan sebagai “gold standard” dalam menilai agresivitas tumor. Maka dari itu, tujuan penelitian ini adalah untuk mengetahui hubungan respon imun pada tumor dalam hal ini sel Lymphocyte dan aktifitas pembelahan sel tumor dengan kejadian penyebaran kanker ke KGB aksila pada operable breast cancer di RSUP Sanglah Denpasar.

Metoda:Lima puluh tiga sampel pasien kanker payudara post MRM (Modified Radical Mastectomy) yang berobat di RSUP Sanglah yang mempunyai catatan medis (data klinis, histopatologis), sampel dipilih secara eligible sampling pada rekam medis pasien di Bagian/ SMF Bedah Onkologi Fakultas Kedokteran Universitas Udayana RSUP Sanglah dari tahun 2016 sampai dengan 2018. Penelitian ini merupakan “Cross Sectional Analitik" hubungan antara TIL dan MAI dengan kejadian metastase KGB aksila pada pasien operable breast cancer     secara univariant, bivariat dan multivariant dengan menggunakan perangkat lunak SPSS 20 for windows.

Hasil: menunjukkan analisa dengan uji Chi-square didapatkan pasien dengan low TIL (P= 0,627), intermediate TIL (P= 0,339) dan pasien dengan MAI  ≥ 25 /10 lp (P= 0,531), MAI 13-24 /10 lp (P= 0,531) tidak dijumpai adanya hubungan bermakna dengan kejadian metastase KGB aksila karena tidak signifikan secara statistika.

Simpulan:tidak dijumpai adanya hubungan bermakna, low dan intermediate TIL memiliki kecenderungan metastase KGB aksila pada Operable Breast Cancer lebih tinggi, dan dijumpai pula adanya kecenderungan makin tinggi MAI, semakin tinggi resiko metastase KGB aksila pada operable breast cancer di RSUP Sanglah Denpasar.

Hubungan antara TIL (Tumor Infiltrating Lymphocyte) dan MAI (Mitotic Activity Index) dengan kejadian metastase kelenjar getah bening (KGB) aksila pada operable breast cancer di RSUP Sanglah, Denpasar.

Korelasi kadar laktat dengan Score for Neonatal Acute Physiology Perinatal Extension II (SNAPPE II) pada neonatus yang dirawat di NICU RSUP Sanglah, Bali, Indonesia

Background: Infant mortality rate is one of the indicators of public health degree that determines the human development index. Various attempts were made to early detect the problems, one of which was by assessing the severity of neonatal disease using Score for Neonatal Acute Physiology Perinatal Extension-II (SNAPPE II) which was associated with lactate levels as a metabolic response and organ dysfunction due to critical illness that were suffered at the Neonatal Intensive Care Unit (NICU).

Methods: A cross-sectional analytic study was conducted among 48 critically ill neonates treated at the Sanglah Hospital Denpasar NICU. Samples were selected from affordable populations by consecutive sampling. Data analysis was performed by Saphiro-Wilk data normality test, correlation analysis using the Pearson correlation coefficient, significant results if the value of p <0.05. Data were analyzed using SPSS version 17 for Windows.

Results: Most of the respondents were males (67%), the mean of neonatal gestational age was 33 (± 3,2) weeks with the median neonatal age at lactate sampling being 24 (24-48) hours. The average age of the mother at delivery was 24 (21-40) years. The mean lactate level in critically ill neonatal patients admitted to the NICU was 3.2 (± 0,5) mmol / L. The mean SNAPPE II score on the subject was 32 (20-42). There was a significant positive correlation between the levels of lactate and the severity of the disease in critically ill neonates in the NICU assessed by SNAPPE II (r = 0.45; p = 0.004).

Conclusion: Lactate levels has a moderate positive correlation with the severity of the disease in critically ill neonates in the NICU assessed by SNAPPE II

The effect of femoral head size on volumetric wear rate following total hip joint replacement surgery

Background: Numerous data records that the number of total hip joint replacement is increasing in many parts of the world which also indicates an increase demand for total hip joint replacement and revision surgery. The purpose of this paper is to review the literature regarding the size of femoral head and its relation to the volumetric wear rate of the polyethylene lining of the hip’s acetabular component.

Methods: A systematic literature search performed to identify relevant publications for this review in five databases: University of Melbourne Science, Medline/ Pubmed, Cochrane Library, and Ebsco. The search was completed on 6 October 2012 and again on 24 October 2012. The following keywords and phrases were used: total hip joint replacement, femoral head size, wear, polyethylene and arthroplasty.

Results: The six studies are all prospective cohort studies with a follow-up time ranging between three to ten years at the minimum. One study conducted by Hammerberg et al. did not mention the minimum length of their follow up however they include a mean follow up period which is 3.6 years. Two studies did not mention the number of patients they are following up. Every other studies mention how many participants included in their study, but these two studies mention how many hips undergo the total hip joint replacement surgery. The number of patients mentioned in the studies vary from the minimum of 42 patients up until 200 patients. The number of hips in each study ranged from 45 hips to 385 hips.

Conclusion: This review concludes that the use of larger femoral head size hastens the wear rate of the polyethylene lining of the acetabulum component.

Neuroendocrine tumor of the gastrointestinal: report of two cases

Introduction: Neuroendocrine tumors are malignancies that need special attention because they provide clinical manifestations that are not typical of excess gastrointestinal endocrine production. Case reports of neuroendocrine tumors are needed to be able to recognize the symptoms and determine the appropriate therapy.

Case series: The first patient was 49 years old Balinese female, consulted from internist with right lower-quadrant tenderness with fever for three days before. The patient also had diarrhea for one week before. The patient has done an appendectomy, and the pathological result of the appendix specimen was Neuroendocrine Appendix. The second patient was 62 years old Balinese male, complained about intermittent diarrhea for two months. Patient has done laparotomy exploration and colostomy because of a transverse colon tumor. The pathological result of the specimen from transverse colon tumor was mixed adeno-neuroendocrine carcinoma. Both patients have been treating with hormonal therapy (somatostatin analogs) long-acting release (LAR); the second patient also had combined with folfox IV chemotherapy.

Conclusion: The choice of therapy with somatostatin analogs in the first case and surgery in the second case gave a good response after treatment. However, in both cases, it does not guarantee the cure of this disease.

Acquired hemophilia – A pada penderita Waldenstrom’s Macroglobulinemia: laporan kasus

Background: Acquired hemophilia A (AHA) is a rare acquired bleeding disease, characterized by autoantibody against factor VIII. Bleeding usually in the skin and mucosal. AHA frequently in the elderly, in male and female and is associated with several conditions, such as autoimmune, pregnancy, drug reactions, solid tumor and monoclonal gammopathy. Half of patients are idiopathic. AHA is diagnosed in patients without previous personal or family bleeding history in which prolonged aPTT is not corrected after mixing and accompanied by a decrease in FVIII levels. Specific antibody that plays a role in inhibiting FVIII activity can be seen from the immonotyphing examination. Waldenstrom’s Macroglubulinemia (WM) is a one of disorders that can cause AHA.

Case Description: A 56-year-old man came with a weak and pale 10 days of hospitalized. Physical examination shown anemia, gum bleeding, lien palpable in Shuffner-1. Laboratory shown bisitopenia and leukocytosis, prolonged aPTT is not corrected after mixing with decrease FVIII levels. (BMP) support Chronic Lympocytic Leukemia/Lymphoma/ Smoldering Myeloma. SPE M-Spike with Immunotyphing examination of IgM lamda monoclonal. History, physical examination, laboratory, BMP, SPE, and immunotyping shown monoclonal gammophaty which cause Acquired Hemophilia A. Bethesda assay examination recommended if FVIII therapy is not responding. Lymphoplasmasitoid cells infiltration and monoclonal IgM production establishes diagnosis of WM.

Three-Port Laparoscopic Sleeve Gastrectomy: Serial Cases Report

Background: Laparoscopic sleeve gastrectomy is the procedure of choice for bariatric surgery. It is a minimally invasive procedure that giving good outcome and less complication compared to other procedures. The multiport sleeve gastrectomy technique is usually described by using 4 to 6 ports and an additional port for a liver retractor. Single-incision laparoscopic sleeve gastrectomy was reported, but not widely adopted.  

Objective: To describe a convenient and applicable modified technique of three ports laparoscopy for sleeve gastrectomy that may give better outcome and cosmetic.

Cases: Four patients were diagnosed with obese class II and III. Upper GI study was performed before surgery. We performed three ports laparoscopic sleeve gastrectomy. The 15 mm port was placed in the umbilical, for the camera. The second 12 mm port was placed in the right side of the umbilical for the stapler, and the third port, 5 mm was placed in the right hypochondrium midclavicular line. During the surgery, we used endoscope as guidance during gastric stapling and also for evaluation the stapler line and the size of the stomach. The postoperative condition was uneventful, the patients have less scar and less length of stay.

Conclusion: Three ports laparoscopic sleeve gastrectomy is easy to perform, convenient and applicable, consume less time and also give excellent results for the patient's recovery.